Safe anaesthesia for all Indians: A distant dream?

Divatia, Jigeeshu Vasishtha

doi:10.4103/ija.ija_454_17

Cited by 4 publications

(6 citation statements)

References 7 publications

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“…This is far below the recommended 5/100,000 population recommended by the World Federations of Societies of Anesthesiologists (WFSA). This ratio is further skewed as the majority of anesthesiologists in India are reluctant to work outside urban areas [ 5 , 6 ]. Unlike many other areas of the world where physician and non-physician healthcare workers are trained to provide safe anesthesia and often work in the rural settings, in India only anesthesiologists are allowed to provide anesthesia care.…”

Section: Introductionmentioning

confidence: 99%

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Delivering Essential Surgical Care for Lower‐limb Musculoskeletal disorders in the Low‐Resource Setting

et al. 2021

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Background Mismatched surgeon-anesthesiologist ratios often exist in low-resource settings making safe emergency essential surgical care challenging. This study is an audit of emergency essential procedures performed for lower-limb (LL) musculoskeletal disorders (MSD) when an anesthesiologist was unavailable. It aims to identify strategies for safe anesthesia. Methods A 5-year retrospective audit of emergency essential LL orthopedic procedures performed at remote mission hospital in Central India was performed. Out of necessity, a regional anesthesia (RA) protocol was developed in collaboration with anesthesiologists familiar with the setting. The incidence of intraoperative surgical and perioperative anesthesia complications when RA was administered by a surgeon was evaluated. Results During this period, 766 emergency essential LL MSDs procedures were performed. An anesthesiologist was available for only 6/766. RA was administered by a surgeon for 283/766. This included spinal anesthesia (SA) for 267/283 patients, peripheral nerve blocks for 16/283. Local infiltration and/or sedation was administered to 477/766. There were 17 intraoperative surgical complications. Anesthesia-related complications included 37/267 patients who required multiple attempts to localize subarachnoid space and SA failure in 9/267 patients all of whom had successful re-administration. Additional sedation and infiltration of local anesthetic was required in 5/267 patients. Conclusion Remote pre-anesthesia consultation for high-risk patients, local surgeon-anesthesiologist networking, protocol-guided management, and dedicated short duration of training in anesthesia may be considered as an alternative for delivering RA for emergency essential surgery for LL MSDs due to unavailability of anesthesiologists.

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Section: Introductionmentioning

confidence: 99%

“…This is especially true in India where despite efforts to try to improve healthcare, there are not enough healthcare professionals to meet the needs of the rural areas and disproportionately even fewer anesthesiologists. This deficiency can make providing safe surgical care challenging [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Delivering Essential Surgical Care for Lower‐limb Musculoskeletal disorders in the Low‐Resource Setting

et al. 2021

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“…However, meeting these standards throughout India has been practically challenging. 1 Having said that, concerted efforts have and are being made to improve the quality of perioperative care across the country by individual anesthesiologists, hospitals, professional societies, and the government. Providing safe anesthesia entails focused evaluation, implementation of protocols, and improvement of structural processes of anesthesia services.…”

Section: Introductionmentioning

confidence: 99%

“…Minimum requirements for providing safe anesthesia have been clearly advocated by the Indian Society of Anaesthesiologists (ISA), the World Federation of Societies of Anaesthesiologists (WFSA), the World Health Organization (WHO), and international anesthesia societies. However, meeting these standards throughout India has been practically challenging 1 . Having said that, concerted efforts have and are being made to improve the quality of perioperative care across the country by individual anesthesiologists, hospitals, professional societies, and the government.…”

Section: Introductionmentioning

confidence: 99%

Quality improvement and patient safety in India—Present and future

Dave

Yaddanapudi

Jacob³

et al. 2022

Pediatric Anesthesia

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India is a vast, populous and diverse country, and this reflects in the state of health care as well. The spectrum of healthcare services ranges from world class at one end, to a dearth of resources at the other. In the rural areas especially, there is a shortage of trained medical personnel, equipment, and medications needed to carry out safe surgery. Several initiatives have and are being made by the government, medical societies, hospitals, and nongovernment organizations to bridge this gap and ensure equitable, safe, and timely access to health for all. Training medical personnel and healthcare workers, accreditation of healthcare facilities, guidelines, and checklists, along with documentation and audit of practices will all help in improving services. This narrative review discusses the measures that have been taken, systems that have been established and the challenges involved in ensuring quality and patient safety in India.

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“…[11] Both articles address an important public health problem. [12] The various solutions offered can be discussed, perhaps as Letters to the Editor in future issues of the IJA, but workable solutions must be found and implemented.…”

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confidence: 99%